Dummy Page
Community Services
In-Hospital Services
Dialysis Clinic, Endoscopy Clinic, Breast Screening Clinic, Library, Coffee Cart, In-Patient Services,
Mary Catherine Scott Suite
Community Services
Marathon Bridge, Craft Group,
Remembrance Garden, Perfectly Preserved Group, Remembrance Fund
Funding Request Form
The Auxiliary partners with organizations that share our mission to support and assist Quinte Health Care, Prince Edward County Memorial Hospital, its patients, staff and the local community in meeting their healthcare needs.
Funding
As a recipient of Prince Edward County Memorial Hospital - Auxiliary (The Auxiliary) funding, and as a duly authorized representative of this organization, I certify that this organization:
● Will use funds provided by The Auxiliary specifically toward the approved funding request and not to substitute without written consent.
● Is a charitable not-for-profit organization or a community service provider within Prince Edward County.
● Practices non-discrimination: (if an agency has a religious affiliation, it will not refuse service to any member of the community).
Will allocate Auxiliary funding on agreed upon products/services, maintain invoices and receipts, and provide them to The Auxiliary upon request.
Signature: ______________________________________
Date: __________________________________________
Please submit this form to fundingPECMHA@hotmail.com
or mail it to:
PECMH Auxiliary Finance Committee
398 Main Street, Suite 3,
Picton, Ontario K0K 2T0
